First Name SHEILA

Last Name FAJARDO

Account Number X36006521639
Client Number 9023414327
Invoice Date 07 JAN 2014

MEDICAL SERVICES PLAN INVOICE

Balance from previous invoice $ 135.75
24 DEC 2013 Payment Received -135.75 Government announced a rate
increase to MSP Premiums effective
January 1, 2014. If you would like
Current Charges more information, see
www.hibc.gov.bc.ca
DATE ITEM DESCRIPTION DUE You can now pay by credit card at
https://www.revenueservicesbc.gov.
bc.ca/pn
07 JAN 2014 Medical Services Plan Premiums 69.25
Coverage: February 2014 For services online go to:
https://www.bceid.ca/register
Total Charges $ 69.25
If paying by cheque, send to: PO Box
Total Due $69.25 9085 STN Prov Govt, Victoria BC
V8W 9E4
**PAYMENT DATE by 27 JAN 2014
The applicable premium must be paid
by the last day of the month (due
You may make advance payments on your account. Based on your current date) as per the Medical and Health
premiums, you can make the following payments for: Care Services Regulation (Section 8).

3 Months 6 Months 12 Months

$207.75 $415.50 $831.00

Person(s) Covered

SHEILA M FAJARDO

**Paying by the payment date will allow for processing time and ensure the payment is applied to your account by the due date.

RSBC 148 Rev.2013/10/17

Please keep the top portion of invoice for your records and return the bottom portion with your payment Page 1/ 1
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Medical Services Plan of British Columbia RSBC Copy
Payable at most Canadian Financial Institutions
Account Number Overdue Balance Current Charges Total Amount Due Amount Payable Amount Paid

X36006521639 69.25 69.25 69.25

Make cheque or money order payable to the "Minister

of Finance".
360065216390030919610

SHEILA MARIE FAJARDO

301-4338 COMMERCIAL ST Do not write or stamp on face of bill
VANCOUVER BC V5N 4G6 ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯

0012177296036006521639000000692500000069251482

000263645460 01484=900 96